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Saturday, August 28, 2010

I know it seems as though I am all caught up in the prayer thing, but here is a post I wrote on August 1, and failed, for whatever reason, to publish. It really should come before "Fired But Not Forgotten," so please, when you read it, go back to that post, my most recent. It is very dear to me.

08/01/10

They stood in a semicircle around the hospital bed, holding hands and listening as the Deacon laid his hand on the dying man’s head and began pray. We were a varied lot, this string of people connected by our hands. The Deacon’s unruly white tufts of hair stuck out in several directions. He was holding my hand - hard. My right hand was snuggled softly into that of a girl about about 17, one of the grandchildren. And on around the bed went the chain - children, grands, another nurse and the Hospice Chaplain, theirs and mine the only white faces in the room. She was holding the patient’s hand.

The praying began in earnest as the Deacon raised his head to heaven and sent up a squall of words to God Almighty, testifying to his knowledge that, though the doctors had given up, The Lord was stronger than all the doctors in the world, that he could send down a miracle and cure this man, this man whose cancer started in his pancreas and spread throughout his frail brown body. Cornrows, perfectly strait and colorfully decorated with beads, formed a sort of rainbow halo over his head.

The Deacon prayed hard, his grip causing my left hand to tingle with sleep, my wedding band to dig into my fingers. Yes, we had prayer. Indeed, we did.

The New Nurse was fired by one of her patient’s caregivers! Her feelings are hurt, but she is coping well.

Here’s the short version: Her patient is 103 years old and is rotting from the feet up. A diabetic for life, she has dry gangrene in both feet and ulcers on her lower legs. She has lost two toes; they just fall off when her dressings are changed. Dressing changes are agony for her and after the New Nurse changed her dressings last Friday, she visited on Monday to see how things were going. The dressings looked good, dry with a few spots of exudate that had not penetrated the outer dressings.

“The dressings held up well over the weekend! They certainly can wait a few days for a change, especially since it it so hard on her when we change them, but if you get worried, call me. We know these wounds will not heal, and our hope is that we can stop them from getting any worse, and I hesitate to put her through a dressing change that isn’t necessary. Here’s my work cell. Let me know if you need a visit before Thursday.”

The New Nurse led the caregiver in a short prayer for the patient to be delivered of her pain and for all of those who care for her to be blessed with healing hands. She departed feeling calmed by the prayer and happy not to have caused any pain for her patient.

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There was a visitor present during the visit, one the New Nurse had never met before, and this is what he heard. “She’s not going to get any better, so what’s the use?” After the New Nurse's departure, he whipped the caregiver into a lather, demanding that she "do something."

Perception is always more powerful than truth, and she called the New Nurse’s boss and complained that the she had shrugged off her aunt’s needs, dismissed her as not worth the trouble.

The New Nurse’s boss soothed the caregiver and assigned her another nurse. Then she called in the New Nurse and told her the news. Tears welled in the New Nurse’s eyes, but she blinked them back. Never cry in the presence of the boss, especially one who is already riding you as though you were wearing a saddle.

In Hospice home care, the week flies by. Time is filled with meetings in the office, scheduling of patients and then, and best of all, the patient visits. They involve driving time and time spent doing hands-on care. The New Nurse nurtures the families and well as the patients, and she often lingers when families appear to need support and encouragement. It is not a 40 hours a week job for her. She rarely stops for lunch, but she is docked for the time - company policy.

She was hired to do part time field work until the new inpatient facility opens, but her boss is working her full time and ragging her ass about overtime. Her boss is a bitch, but she is only trying to do her job. The New Nurse imagines that her boss is being pressured from above to keep costs down.

(Wonderful, isn’t it, that caring for the sick and dying is just as bottom-line driven as the layoffs at Wal Mart)?

Thursday rolled around, and the New Nurse was caring for another elderly woman, this one in her 90’s, when her cell phone rang. She ignored the call, not recognizing the number, but returned it when she was finished with her visit.

“Hi, this is the New Nurse, and I missed your call because I was with a patient. What can I do for you?”

“Oh, New Nurse, this is Mary.* You know, we had prayer when you visited my Auntie on Monday. Where have your been?”

“Mary, sweet Mary, when you called my boss she took me off your case and assigned you another nurse. How are things going?”

“She’s okay, but she can’t pray like you. I didn’t mean to get you in trouble. I’m sorry we lost you. I was upset and didn’t really understand.”

“How about this, Miss Mary. How about I call you every few days and we can pray over the phone?”

“Can’t you come by and visit?”

“I’m so sorry, Mary, but I am forbidden to visit any more. I will call you, though, and we will visit and pray together. Here is a prayer I know by heart. It’s called St. Teresa’s Prayer. Close your eyes and listen.”

May today there be peace within.

May you trust God that you are exactly where you are meant to be.

May you not forget the infinite possibilities that are born of faith.

May you use those gifts that you have received, and pass on the love that has been given to you.

May you be content knowing you are a child of God.

Let this presence settle into your bones, and allow your soul the freedom to sing, dance, praise and love.

Sunday, August 22, 2010

She punched the “off” button on her phone, dropped it onto the bed, put her face in her hands and wept. Her son had called from the mental hospital where he admitted himself when the voices came back, and she was overcome with angst.

Since he once told her that the voices told him to kill his father and stepmother, she didn’t ask what they said. Though so dangerously ill, he realized that telling her would wound her even more, so he stopped telling her long ago.

She searched for some solace, some relief from the pain that penetrated her entire being and found it is the fact that her son had realized he needed help and and sought it. It was no silver lining to the clouds hanging over her head, but it was something to which to cling.

The voices weren’t always there. They began a few years back, before her son’s diagnosis was changed from rapid-cycling bipolar disorder to schizoaffective disorder. He didn’t tell her at first. He was living on the streets of Atlanta, and she didn’t know where he was. He was admitted at intervals to the state mental hospital in Atlanta, and during his last admission, he called her and told her everything.

But he had not yet toed the famous “bottom” - the one that alcoholics and drug addicts and mentally ill people need to hit before they can begin to heal. That happened after he he found himself in Miami, living in a shelter.

The state of Florida takes better care of its mentally ill than does Georgia. A state social worker visits homeless shelters and reaches out to the residents who have mental issues, and her son was in rehab within a couple of weeks. He had to get off drugs and alcohol before anyone could accurately assess the status of his mental illness.

But he still had not hit bottom, and after two weeks was back on the streets, sleeping in parks and shelters. When the social worker found him again, he was ready to start down the long road to some stability in is life, some sense of sanity, however driven by pharmaceuticals it may be. Some people cannot function without the proper drugs to stabilize their brain chemicals.

The social worker found him a place to live and worked with Social Security to have him declared mentally disabled and eligible for benefits. He also had him declared physically disabled as well, as he had suffered two failed spinal funsions in the past.

Her son lives in an assisted living facility (ALF), he sees a psychiatrist once a week and is involved with a state run program that includes computer training, group therapy and 12-Step meetings. His medicine is doled out by a nurse at the ALF, and he is stable most of the time.

He hates where he lives. The other residents are Cuban and only one of them speaks English. Her son’s Spanish is approaching the fluent stage, so he communicates fairly well with them, but not one of them is college educated, well read or on a par with his intelligence. He is lonely and humbled by his living situation.

His mother wants to move him closer to her but she is afraid of what the change might do to him. As much as he complains, he is entrenched in a pattern of living where he is, and he knows what each day will bring. She worries that a move to Georgia would strip him of the structure he has in his life, however humbling it might be.

There is a saying among people who live by 12-Step programs that says it is best to remain where one gets sober, best to stay away from the places where one did nothing but drink and drug and be unstable. In the town where his mother lives, there is only a skeleton of a program that might benefit him.

Tuesday, August 17, 2010

The Hell Bitch has a heart! Yesterday, when I arrived at work, there was a list of ten patients for me to see this week - by myself. I felt as though someone had dragged me up on the high dive and thrown me into the deep end of the pool.

My orientation is far from complete. Oh, I can do the patient care, but we have reams of paperwork, and The Hell Bitch has been doing it. I don’t have a laptop yet, so it was easier for her to take care of it. I was expecting to be oriented to all the paperwork and my laptop - before being set out on my own.

I felt overwhelmed, anxious and completely caught off guard, and when I walked over to The Hell Bitch’s desk to tell her I was longer hers, I was fighting back tears. She stood up and wrapped her big arms around me and hugged me tight, saying I would be okay. I was never so shocked.!

Yes, she is still a Hell Bitch and always will be. That is who she is, but now I know she has a heart, and casts a new light on her bitchiness. It is more bearable, but now that I have been throw off the high dive, I won’t be working with her one-on-one anymore.

Sunday, August 15, 2010

For the past week, I have been doing home visits with The Hell Bitch. After working with her one day week before last, I asked that she be my preceptor. (Yes, I did a four-week hospice preceptorship back in the spring in order to reactivate my nursing license, but now that I have been officially hired by Hospice of Central Georgia, I must do another one. The first one was all field work with no orientation to paperwork or checkoffs for specific procedures - starting IVs, inserting catheters, drawing blood for lab work, etc.).

The Hell Bitch is one of the smartest, most knowledgeable nurses with whom I have ever worked - probably the best nurse I have ever seen, so knowing what I was getting into, I requested her.

So far, she has taught me how to detect a heart murmur and now to titrate pain meds for our patients. When I graduated from nursing school, in 1969, nurses weren’t even allowed to do cardiac assessments and we sure as hell weren’t allowed to make decisions about medications. So, I am a reborn nurse, swimming in unknown waters, still feeling as though I need to call the doctor for advice on medication.

The Hell Bitch will not only go toe-to-toe with our medical director, she will push her agenda on him, challange him to see things her way. The woman has balls. Then she wonders why he runs in the other direction every time he sees her rumbling toward him. Naturally, she feels picked upon.

We recently converted from paper charts to electronic records, and she is the only one in the office who has mastered the operating system and navigates it with ease. Some of the others are making progress, and one nurse has refused altogether to use the laptop assigned to her and will probably resign because of it.

You are probably a little curious about the Hell Bitch part. Fair enough, so here goes.

She is a diabetic and doesn’t watch her diet, so part of the time her blood sugar is out of whack and she is fractious and spiteful when it is low. She will argue with a lamp post - about anything, if she thinks she is right, which is 100% of the time. I think she would even argue knowing she is wrong, just to bully the other person. I have heard her admit a mistake once, but the utterance it was barely audible.

She complains loudly, and I do mean loudly, about most of her patients’ caregivers and families. While we are driving from town to town, in her strident voice, she dissects every little weakness and foible. As for me, I don’t give a rat’s ass if the son has heart disease and won’t take care of himself. He is a grown man, and though in my heart I wish he would eat right and take his meds, my primary focus on the patient and the caregivers that I can work with. The ones that are recalcitrant have to go to the back burner while I work with the ones I can.

Jesus. I sounded like The Hell Bitch for a moment.

She hates everyone in the office except two nurses. (I’m not sure yet whether or not she hates me). And she while we are on the road, she treats me to diatribes about each of their weaknesses. Nobody does the job like it should be done - except her. She has pointed out who the manager’s pets are and warned me to “keep my head low and don’t offer an opinion unless asked.” This from a woman who, as soon as we arrive back into the office, swaggers her very ample personage into the office and begins to rale against this person or that situation.

As for me, I am willing to put up with The Hell Bitch in order to drain her of any knowledge I can take in. I am not in this line of work because I am a sissy, and though she outweighs be about three to one, I am fully capable of wading right into that pool of negativity if I think she is wrong or unfair. And she knows it.

Meanwhile, I went to the candle store and bought myself some jasmine candles to burn at home. According to Hothouse Bath and Body News, it has a sedative effect much like Valium. I’m burning one right now, and I think it is working.

And I bought some jasmine hand sanitizer - one bottle for me and one for The Hell Bitch. I hope she doesn’t throw it at me.

Tuesday, August 10, 2010

What is it with me and men? Either they die on me or I push them away. I’ve had a fight with my Friend-Boy, and it may cause an irrevocable rift in our relationship. We both said things we shouldn’t have said, did things we shouldn’t have done, and now I am lonely and missing him.

He has a right to be mad at me, and I have a right to be mad at him. It’s just that I want to make up and he doesn’t. Shit.

I had a session with my therapist this afternoon, and she, who takes no prisoners, says she thinks we will be okay. I don’t know. Since Clint died, I have not been the strong and centered and self-confident woman I used to be. Oh, I’m making a comeback, but this is just so hard.

I don’t want to go into details, well, just because I’m not ready to share them with anyone except my therapist, but I will say that it is ugly.

Not fair to tease my readers? True. But I need to share my feelings with those who care about me, and I will say that he and I are not sexual; we are truly friends - without benefits, at least not that kind.

I am giving him space and hoping for the best. And as much as I want to believe that we will weather this storm, I am still afraid of losing him. See what I mean about men and me? I have lost so many men, starting with my father at the age of six, followed by my brother at age 12 and another brother ten years ago and ending with Clint’s death last June 10, at 6:33 PM, and after all that loss I believe I may have actually caused another one.

I’ll tell you a little bit about my Friend-Boy. He’s a retired physician; he was Clint’s physician until he retired. Our relationship goes back years, thirty years. He is funny and intelligent and well read and very metro - a rarity in Macon-Fucking-Georgia. He makes me laugh.

Here’s an example: When I am depressed, he does things like calling me up and asking to speak to Sylvia.

“Ms. Plath, take your head out of the oven. This is the gas company and we have turned off your service, so take you head out of the oven and meet me for dinner.”

We are both Pink Panther Fiends, and we speak Pink Pantherese fluently. I have been known to call him up and say, “This is Officer Bardot, but you may call me Brigitte. How about a little stroll through the Bois de Bologne?”

Sunday, August 8, 2010

(I’m sitting on my deck drinking coffee and writing! Yes! It is cool enough to actually sit outside and breathe some air that doesn't feel like it was just blown out of a furnace. Just a little aside before I start my post. Had to share).

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The New Nurse took things into her own hands. After working on a pain management manual at her desk for a couple of hours, she wondered when her manager was going to give her her marching orders for the day. Lavender Lane, the hospice where she works, was still in turmoil after moving into the new building.

She knew what the schedule paper said. It said that she was to spend the morning with either one of the chaplains or one of the social workers, but the morning was fast dissolving all around her. She was ready to get out of the office and see some patients.

The desk directly behind her is assigned to the night nurse, but since the night nurse was at home sleeping, Brenda, one of the social workers was using it. The New Nurse wheeled her chair around and asked, “What’s up with you today?” Teresa and I are supposed to be with one of you guys or one of the chaplains. Can we go with you?”

Pause.

“I don’t see why not , but we won’t be back at the office until four this afternoon. You up for a long day?”

At that point, Teresa wandered into the new nurse’s space with a look of anticipation on her face.

“Aren’t we supposed to be doing something?”

Never having been accused of being shy, the New Nurse pulled herself out of her chair, which was a little deep for her, and strode across the hall to Katie’s office and, interrupting her, asked permission to go with Brenda.

Katie slapped her forehead and said, “Oh, shit! I knew there was something else on my plate. It’s just so full, I have to move everything around on it to see what’s there. Sure, tag along with Brenda. Hey, and thanks for being proactive. Go with my blessings” Then she returned to her conversation with another nurse.

The ride to Barnesville, mostly over country roads, was beautiful with deep green flora, recent heavy rains having produced a lushness in the landscape, unusual for these hot days of August.

**************************************

The New Nurse tried to watch and listen as Brenda interacted with the family of the dying man. Having been admitted the day before, his family had only received his medication packet that morning. While Brenda’s voice began to sound like Charlie Brown’s teacher, the New Nurse could not take her eyes off the skeleton of a man in the bed. He was sucking for air and beginning to rattle. He had periods of apnea for as long as 30 seconds, followed by respirations as frequent as 30 in 30 seconds as he struggled to move air into his lungs. She held herself in check as long as she could.

No stethoscope or blood pressure cuff, no nursing apparatus at all, she interrupted Brenda, saying, “I must intervene her and be this man’s nurse.”

She explained to the family that their loved one was hungry for air, and that he needed some medicine to make him breathe easier and alleviate any pain he was having. He was nonverbal, so there was not way to assess just how uncomfortable he might be. She had the family look at his breathing, then opened the medication box, assembled the apparatus for delivering morphine drops under his tongue and guided the niece in how to administer it.

The New Nurse took the frightened woman into her arms and whispered, “He is leaving us, and he knows it. We all know it. Your giving him morphine will make his leaving easier and more peaceful. By giving it to him, you are ministering to him, helping him along his way.”

Within five minutes, the patient’s breathing was less labored, though he was still having periods of apnea.

Then the New Nurse opened a tiny bottle of drops meant to dry the patient’s chest so the rattle would be less and maybe even go away. The niece was eager to give her uncle the medicine and was guided in doing so by the New Nurse.

They sat for a few minutes as the New Nurse guided the family through the signs of end of life, explaining that their uncle had some of them but not all. Though they had read the material on that subject given to them on the previous day, then remembered little of what they had read and needed gentle reinforcement.

On the drive back to the office, the lush countryside appeared even more verdant. New Nurse called the dying man's case manager and confessed to having intervened with her patient and was greeted with these words:

“Hell, Claudia, you’re a hospice nurse. You were just doing your job. We will write it up when you arrive. I am thankful you were there.”

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synchronicity: the simultaneous occurrence of events that appear significantly related but have no discernible causal connection

I have long believed in synchronicity in the lives of people and what happens and does not happen in them, and I am certain in my heart that a powerful force in the universe - call it what you want - moved me to stick my nose in Brenda’s business and ask to go with her. It was an intervention outside of me and my spiritual capabilities that led me to that bedside on a hot August afternoon in Barnesville, Georgia.

Sunday, August 1, 2010

Her coworker, Debra, drove as they passed through the countryside, and the new nurse sat and stared at the form in her hand. Diagnosis: Renal Cell Carcinoma. The cancer that killed her baby brother had attacked one of her patients, and now it would be her job to help him die, not in the way that she helped her brother die, but it would fall to her nonetheless.

She blinked back tears as she wracked her brain for a path to strength, searched deep for the ability to put a smile on her face, a real smile, not just one pasted on for the benefit of her patient. He would doubtless see though it anyway. The dying have x-ray vision, she thought to herself.

The drive to his home would take three quarters of an hour, and since Debra was prattling on about purple crepe myrtles, it was hard to think, almost impossible to concentrate.

True, this new patient is 30 years older than her brother had been when he died at 45. But somehow there was no comfort in that knowledge. It was the same disease that sent her and John - that was her brother’s name - to Memphis for three weeks of alternative treatment at the end of his life. She thought she could will her brother to stay alive, that if she didn’t want him to die, well, he wouldn’t. Denial is deeper in health care professionals that in anyone else, she had decided.

She was planning to write a book about her brother’s short yet remarkable life but had been put off by her desire to keep that wound closed. After 10 years, it was still simmering under the surface of her psyche, and she was unsure, in view of her husband’s death just a year ago, that she was emotionally and psychologically capable of taking on that task without throwing herself back into the deep and dangerous depression that still haunted her.

What to do? She decided on the direct approach. She would tell her patient up front that she had lost her brother to the disease that was now killing him. Unsure of just how she would negotiate those whirling waters, she knew she needed to tell him.

So much so soon, she mused to herself as her Debra pointed out every fucking color of crepe myrtle they passed. Why is it that life has to jackhammer me at every turn? Why can’t life ease its punishments on me? God knows there have been enough of them. Do they all have to be hurricanes? Can’t some of them come quietly like a much needed shower of rain in the 98º heat of this day?

And then, there they were, at the patent’s house. Still without a firm plan in mind, she followed the Debra into the house, and much to her own surprise, asked her partner to handle the visit, volunteering to take vital signs and do the physical assessment only. Incredibly, Debra locked eyes with her and there was understanding and compassion in them. She knew. For training purposes, Debra had taken only a supporting role in the previous visits, but she remembered her fellow nurse’s tragic history with renal cell carcinoma and seamlessly moved into the leadership role.

As the visit came to an end, Debra offered to pray for the patient. She did that a lot. So, she prayed for a while, covering all her bases with Jesus and the Holy Spirit, asking for strength and guidance and all that. The patient punctuated her words every now and them with a “yes” or and “amen.” The patient’s brother was visiting, and he also lent his voice to the “amens”

The new nurse was quiet, remembering all her unanswered prayers for her brother’s recovery. All that praying had just brought him to a place where his heart and lungs, filled with tumors, got too tired to go on.

After the praying was over, Debra sang a hymn to the patient, and when she finished, the brother looked at the new nurse and said, “You need prayers, too. There is something in you that makes me know you are hurting.” And that is when she, in a hesitant voice, admitted her very personal connection to renal cell carcinoma.